Black adults born in the United States are more likely to experience moderate-to-severe psychological distress than Black adults born abroad, according to a study published in JAMA Network Open.
“Black or African American individuals have often been examined as a monolithic group,” wrote Maryam Elhabashy, B.A., and colleagues at the National Institute on Minority Health and Health Disparities. Yet, in 2022, “11.8% of Black or African American individuals were non–US-born, and the proportion is projected to be 13.0% in 2035 and 16.6% in 2060. This necessitates more research that considers the diversity in this population.”
The researchers examined responses from 49,820 Black adults (58% female) who completed the National Health Interview Survey between 2005 and 2018; of these respondents, 43,885 were born in the United States. Part of the survey included the Kessler Psychological Distress Scale, which features six questions about how often respondents have felt sad, nervous, restless, hopeless, worthless, or that everything was an effort in the past 30 days.
Overall, 22.6% of U.S.-born Black adults reported moderate-to-severe psychological distress (a score of 5 or higher on the Kessler Scale), compared with 17.4% of those not born in the U.S. Non–U.S.-born individuals who were married or living with a partner had the lowest probability of experiencing psychological distress, while other types of marital status had no effect. In contrast, being married or living with a partner did not reduce the risk of psychological distress in U.S.-born individuals, but being divorced or separated did raise the risk.
Alcohol and health insurance also had different impacts depending on nativity; U.S.-born individuals, but not those born abroad, had less risk of psychological distress if they were never drinkers or insured.
Across both groups, being unemployed, having less than a college education, living below the poverty income threshold, or being a current/former smoker raised the risk of psychological distress, though the first two items were more potent in U.S-born individuals while the latter two were more potent in non–U.S.-born individuals.
Elhabashy and colleagues said that poverty may be an important factor for non–U.S.-born individuals due to additional financial obligations such as remittances and the stress of maintaining household well-being in two countries. “On the other hand, unemployment and education as factors among U.S.-born individuals may be associated with systemic racism and the diminished return of educational attainment on Black adults’ subjective health.”
For related information, see the American Journal of Psychiatry article “Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults.”
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